La droga es el camino equivocado

In whatever way the waning birth rate in New South Wales is viewed, whether in its effect on the health, character, or social worth of individuals; on the value of the family as the basis of national life; on the quality and dignity of civic life; on the character of the people; on their social, moral, and economic progress; on their national aims and aspirations; or on their capacity to survive in the rivalry of nations; and whether it is viewed in the light of history or of science, it is seen as a grave disorder sapping the vitals of a new people, dispelling its hopes, blighting its prospects and threatening its

continuance. (The Royal Commission into the Decline of the Birth Rate in New South Wales, 1904).

Introduction

In Britain, despite the growing recognition of the importance of poverty, an overriding medical concern with heredity and racial deterioration ushered in the twentieth

century (Rose, 1985). For example, the problem of physical deterioration was emphasised in White’s Efficiency and Empire published in 1901(White, 1901). In 1903, a Special Report to Parliament by the Inspector General of Recruiting warned the government that the degraded physical state of the population, observed during recruitment for the Crimean War, was a direct threat to national security (Gilbert, 1977:152). In 1904, the Interdepartmental Committee on Physical Deterioration reported that the widespread physical weakness amongst the working classes was caused by poverty, malnutrition and disease, and was exacerbated by dirt, neglect and ignorance. In these reports the qualities of moral, physical and social degradation were consistently conflated. The inexorable connection between the three was further compounded by the view that deficits, whether moral or physical, could be acquired or inherited, and that acquired characteristics could become hereditary. The central concern with heredity, however, meant that solutions to the problem of racial

degeneration were posed in terms of the reproductive capacity of the population, primarily the reproductive capacity of women.

It was observed that adults who came to reproductive age already damaged by environmental squalor or hereditary burden produced inferior children. Sanitary conditions were still important, but the central focus of medical effort shifted to the conditions of reproduction. Providing for the health of children and the health of mothers became a vital concern. In Britain, this shift correlated with a medical acceptance of birth control as a strategic intervention in the dynamics of population and the establishment of the right to ‘procreative information’. In the final decades of the nineteenth century, secular social reformers argued that the conditions of abject poverty amongst the lower classes could be ameliorated by the provision of birth control information. In opposition, philanthropic groups argued that the practice of contraception would merely conceal immoral behaviour. In 1886 Charles Bradlaugh and Annie Bessant were prosecuted for the distribution of an ‘indecent’ publication, the pamphlet The Fruits of Philosophy1_{. Their conviction in 1887 was subsequently}

quashed on appeal, opening the way for wider accessibility in Britain to procreative information (Magnussan, 1990). In medical terms, birth control offered the

opportunity to enhance the reproductive capacity of ‘fit’ mothers, while the

reproduction of the ‘degenerate’ could be minimised. In Australia, however, parallel concerns with the dynamic of population as the key to national security manifested in a different way because, at the turn of century, the quest for national security was seen as fundamentally dependent upon the numerical strength of the population.

The contraceptive debate in Australia

Toward the close of the nineteenth century, in Australia public lectures were held, and pamphlets distributed, that advised upon the use of contraceptives. Following the British example, however, William Collins was prosecuted in 1888 under the provisions of the Obscene and Indecent Publications Act (NSW) for selling Annie Bessant’s pamphlet the Law of Population. The Full Court of the Supreme Court of

1 _{The Fruits of Philosophy was written in American by Dr. Charles Knowlton in 1832 and was widely} distributed by neo-Malthusian groups in Britain.

New South Wales decided that birth control literature should not be regarded as obscene2. The comments of the court were so celebrated by supporters of the birth control movement that passages from Justice Windeyer’s judgment were published internationally. Following the judgment, demand for contraceptive information

remained strong. For example, the Syme Family republished The Fruits of Philosophy the three times during the 1890s. As in Britain, secular reformists supported the provision of contraceptive information as a tool for the alleviation of poverty through the restriction of childbearing.

Also prominent was the argument that focussed on the rights of unwanted children. Mrs Bettina Smyth of Melbourne argued in The Limitation of Offspring that the provision of contraceptive appliances was necessary to prevent the hundreds of deaths of unwanted infants each year. She claimed these infants were either murdered, or abandoned to a slow death in foundling homes (Seidlecky, 1990:17)3. Australian medicine, however, did not embrace contraceptive practice. Instead they exhorted Australian women to attend to their ‘duty to society’. For example, in 1897 the president of the New South Wales Branch of the British Medical Association urged women to

….recognise that the law of her physical life shaped her destiny and dictated without compromise her physiological duties (quoted in Seidlecky,1990:16).

The concern with the popularity of contraceptive practices was amplified by statistical analysis. In 1900, an essay published by the government statistician of New South Wales, entitled Childbirth in New South Wales: a study in statistics, warned that the project of population expansion was failing (Deacon, 1985:34) 4. Minimal

immigration, coupled with a fall in ‘natural increase’ had resulted in a numerical decline in population that seriously impacted upon the stability and prosperity of the nation. Coghlan attributed the population decline to the general trend amongst women to ‘avoid’ their biological function, exemplified by the ‘common practice’ of

2 _{Ex-parte Colliers, Law Reports NSW, Vol 1X (1888) per Windeyer J, Stephen J, with Darley J. in} dissent.

taking precautions against the birth of children. While he conceded that these practices were an acceptable feature of social conditions in the ‘old country’, their extension to the ‘new country’, where population was so much desired, was

unacceptable (Seidlecky,1990:14). Australian women were endangering the project of national security by deliberately restricting childbearing.

In 1901 the New South Wales Government revised the Obscene and Indecent Publication Act in an effort to limit the availability of contraceptive information in that State and in 1902 the New South Wales Supreme Court modified its liberal stance on ‘indecent publications’5. Medical criticism of women’s behaviour also became pointed. For example an editorial in the Australian Medical Gazette argued that

…for some reason or reasons, women of today decline the responsibility for maternity and resort largely to artificial preventives against conception, and if conception does occur they resort to abortionists to get rid of their burdens (Editorial, 1903:521).

The intensity of public discussion prompted the government of New South Wales to appoint a Royal Commission to investigate 'the causes of the decline of the birth-rate in New South Wales and the effects of the restriction of child bearing on the well- being of the community’.

The 1904 Royal Commission

The Royal Commission primarily based its findings on statistical evidence and medical opinion. Population statistics in New South Wales showed that there had been a 30% decline in the birth rate over the last 15 years. While this figure was contributed to by factors such as the postponement of marriage, a decline in fecundity, 4 _{Mr. T Coghlan was the government statistician for New South Wales held from 1886 to 1905.}

5 _{Patter v Smith (State Reports NSW Vol. 11 (1902)) failed to attract the public attention accorded to} Ex-parte Collins

a cessation of fertility at an early age, and a decline of fertility at all ages these were not the primary cause of the decline (Mackellar, 1904:6). Similarly, the age and constitution of the population, the age and constitution of women of conceptive age, the marriage rate, the physiological tendencies toward lessened fertility, birthplace of husbands and wives, and ‘all other natural causes’ were deemed to have little

statistical relevance (Mackellar, 1904 10-12). A statistical comparison between Australia and New Zealand also showed that the falling birth rate in Australia was independent of economic decline. As all ‘possibly relevant’ had been excluded, the Commission accepted the statistical evidence as proof that fertility was ‘a force over which individuals themselves have control’ (Mackellar, 1904 #450:14). They identified the ‘deliberate prevention of conception’ and the ‘deliberate destruction of embryonic life’ as the ‘immediate’ causes of fertility decline (Mackellar, 1904:15). As these matters fell within the medical realm, the Commission called forward medical witnesses.

Contemporary medical opinion regarded ‘interference with the reproductive capacity’ as profoundly debilitating. The female body was thought to be incapable of healthy function in the absence of pregnancy and childbirth, and a delay in procreative function was linked to temporary or permanent disability of the reproductive organs and ‘pathological sterility’ (Mackellar, 1904:17) 6. Medical opinion also linked the prevention of conception with insanity in women. Failure to reproduce was thought to have deleterious effects upon the nervous system, leading to mental instability, nervous disease, hysteria, neurasthenia and insanity. The deliberate destruction of embryonic life also carried an extreme legacy. Doctors attributed the marked increase in pathological gynaecological conditions, and the 50% increase in the maternal mortality between 1890-1902 to the ‘common’ practice of embryonic destruction7.

6 _{Pathological sterility was thought to result from congestion of the circulation, uterine disease,} destruction of the organs of generation, or septic inflammation of the womb and its extension to other organs.

7 _{The Royal Commission rejected evidence from one medical witness who suggested that the} reproductive capacity of the population was being destroyed by ‘meddlesome, bad gynaecology’ (at p98). It is significant that the 1904 Royal Commission was conducted towards the end of a period in which the ‘midwifery’ share of obstetric work, estimated at ‘well over half the confinements’ in the 1880s, was already well in decline (Willis, 1989[1983]:98). Never the less, at the time of the commission, the death of women in and following childbirth was attributed to the ‘deliberate and unnatural’ practice of women attempting to obtain relief from ‘unwelcome encumbrance’ by resorting to a ‘degrading crimes’ such as induced miscarriage or infanticide. It was assumed that women that women were assisted in these ‘crimes’ by ‘midwives’. An alternate explanation, that medical

In addition to investigating the decline in the birth rate, the Commission was also invited to conduct a general investigation into the ‘mortality of infants, whether and to what extent infant mortality was preventable, whether it was increasing, and the nature of its relationship to the prosperity of the state’ (Mackellar, 1904:3). The Commission listed the multiple causes of infant mortality as the problems of

premature birth, defective care, the ill health of mothers, lack of maternal knowledge, bad food, bad milk, a lack of hospitals, epidemic disease and summer diarrhoea. These problems were most acute in ‘defective homes’. The principal problem, however, was the practice of secret adoption, the separation of infants from mothers, and infanticide. The rising infant mortality rate, therefore, was essentially another manifestation of the desire to ‘interfere with procreation’.

Not only did interference with procreation effect the individual health and sanity of women, it degraded the mental and moral conditions of the population, and

endangered the social fabric. Practices of interference resulted in a loss of self- respect, a loss of respect for one’s spouse, a distinct degradation of the character, and a general lowering of the moral standard of the people (Mackellar, 1904:21). Families with insufficient numbers of children produced individuals who were morally,

intellectually and physically less well equipped for ‘the struggle of life’. Small families diminished the quality of the population by disabling the capacity of the family to forge morally capable citizens (Mackellar, 1904:28). In contrast, the effect of large families was to stimulate a ‘conscientious regard for duty and to promote good citizenship’.

Population decline was also a serious threatened national security. With only a small population, Australia was thought vulnerable to invasion from surrounding nations. Russia and Japan were ‘seeking outlets, beyond their own borders, for the energies of their ever growing people’ (Mackellar, 1904:53). In the face of this danger, the

attendance at births was responsible for a rise in puerperal infection resulting in both an increase in deaths and in progressive gynaecological complications, was beyond the reach of medical or statistical knowledge at the time of the inquiry. Similarly, the possibility that unrecognised venereal disease was a cause of gynaecological disease in the general community was absent from the medical commentary.

estimated loss of 940,000 people, in New South Wales alone, from ‘interference with procreation’ made Australia vulnerable to invasion (Mackellar, 1904:53) 8.

The right to motherhood

Having established that interference with procreation was a threat to the health, sanity and life of women and infants, a burden on the social fabric and a peril to the security of the nation, the Commission considered a range of strategic interventions it would stem the practices of contraception, induced miscarriage, and infanticide and child disposal. To limit access to contraception, the Commission recommended that the sale and distribution of all contraceptive devices be banned, and contraceptive information deemed ‘immoral and obscene’9. The general provision of abortifacient

pharmacopoeia was to be restricted by transferring the distribution of these to medical control. This recommendation was aimed at restricting their use by ‘druggists and hawkers’, thus rendering inert the multiple remedies and treatments for ‘nervous disability in women’ that were considered veiled advertisement for abortifacient drugs. In order to limit the occurrence of induced miscarriage, ‘private’ hospitals were to be placed under medical supervision and midwives, as both the assumed practitioners of various techniques for interfering with procreation, and the complicit participants in the practice of infanticide, were to be subject to regulation, training and medical supervision. Midwives would also be required to record the outcomes of their attendance on women in a ‘still birth register’, as well as the Registry of Birth and Deaths, so that these administrative tools could be utilised in the ‘prevention and detection of crime’ (Mackellar, 1904:49). To improve maternal health the

Commission advocated improvements in the general care of women in childbirth, including increased public hospital accommodation, increased care and

accommodation for women with venereal disease, compulsory notification of

8_{. Similar warnings were voiced in America. ‘Among human beings, as among all other living} creatures, if the best specimens do not, and the poorer specimens do, propagate, the type [race] will go down. If Americans of the old stock lead lives of celibate selfishness… or if the married are afflicted by that base fear of living which, whether for the sake of themselves or their children, forbids them to have more than one or two children, disaster awaits the nation’ (President Roosevelt, 1903).

9 _{In relation to information legislative change was thought unnecessary because these items could be} listed under the provisions of the Obscene and Indecent Publications Act (NSW), automatically enabling their exclusion under the provisions of the Customs Act.

puerperal fever, and improved ‘instruction of mothers’. The purpose of these strategies was to bring pregnant women more firmly within medical supervision.

The medical supervision of women was necessary because of the trend toward ‘maternal indifference’. The Commission found that many Australian women

exhibited an inappropriate love of luxury and social pleasures. This was an expression of the ‘decadent state of society’, equally evident in France, England and the United States, that encouraged a ‘perversion of human nature’ that drove women to seek reproductive limitation. Women were increasingly unwilling to ‘submit to the strain and worry of parenthood’, actively eschewed ‘any interference with pleasure and comfort’, and pursued their desire to ‘avoid the physical discomfort of gestation, parturition and lactation’ (Mackellar, 1904:8). Medical witnesses to the Commission reported that at least 50 % of their female patients made open inquiries about

availability of contraceptive and abortive products with ‘no sense of shame or wrongdoing’ and that the topic of contraception was a ‘common subject of conversation amongst gatherings ofwomen of all classes’ and ‘freely discussed’ within groups of women of mixed marital status (Mackellar, 1904:8). Women who openly sought medical assistance in these matters exhibited a misplaced attitude toward their social responsibilities. As the Medical Gazette echoed at the time of the Commission’s report.

Barrenness is a disgrace and a sign of weakness, the glory of motherhood must be emphasized and the woman who enters the married state with the deliberate intention of having no children, who seeks gratification of the sexual passions without the responsibility of motherhood, should be regarded as no better than a mistress or a prostitute. (Australian

Medical Gazette, Editorial, 1904).

The Commission thought that women’s claim to political suffrage were merely a ruse to disguise their decadent preferences. Instead of pursuing civic participation, the Commission urged women who claimed a place in the political life of the nation to express that ‘precious freedom’ by producing children. This was because

…the effort of the race towards its increase in numbers is in inverse ratio to the effort of the individual towards personal development (Mackellar, 1904:9)

Motherhood was the only fully moral form of female behaviour, and it was through motherhood that the vitality of the population, and the strength of nation could be secured. Women’s civic attention should be refocussed upon the right of honest mothers, struggling to maintain the life health and of their infants, to safe conditions for childbirth and motherhood.

Conclusion

Royal Commission of 1904 affirmed a unique relationship between medicine and government in Australia that would be maintained through the following decades. On matters of population, medical expertise would be consulted and medical views would form the basis of government programs. In the instance of population decline, the link between the prosperity and the security of the nation, and the ‘vitality’ of the

population, through the reproductive capacity of women, dictated that the moral condition of women became the primary object of medical deliberation, and the moral tutelage of mothers an important strategy of practical medical intervention10. One effect of this nexus was to bring the practice of midwives further beneath medical supervision, and to further entrench the expansion of medical supervision in obstetrics. The vision of universal medical supervision of women opened the possibility of medical identification and differentiation amongst them. ‘Honest’